Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid

Bosworth, Hayden B.; DuBard, C. Annette; Ruppenkamp, J.; Trygstad, Troy; Hewson, Denis Levis; Jackson, George L.

doi:10.1007/s13142-010-0007-x

Cited by 25 publications

(40 citation statements)

References 65 publications

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“…The intervention in the US study reported by Bosworth et al 277 was a tailored multifaceted programme delivered during regular telephone by a registered nurse with the aim of increasing medication adherence. Compared with baseline, adherence to medication improved a year post-intervention.…”

Section: Intervention Description and Resultsmentioning

confidence: 99%

“…In the routine care of people with hypertension, a whole-systems approach to supported self-management, combining patient-, professional-and system-level interventions, was effective in improving adherence to mediation 277 and reducing BP.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies in hypertension were included (see Table 122 for details): 276,277 one from a primary care setting in Germany 276 and one from a managed care programme in the USA. 277 Quality assessment and weight of evidence Both studies analysed before and after data, and the quality assessment scores (14 and 15 out of a total of 28) reflected the limitations of this methodology.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…277 Quality assessment and weight of evidence Both studies analysed before and after data, and the quality assessment scores (14 and 15 out of a total of 28) reflected the limitations of this methodology. Studies failed to report (a) patients lost to follow-up, (b) the characteristics of patients lost to follow-up, and (c) confounders.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…247 Patients perception of community health-care workers as peers (as opposed to professionals) enabled them to form relationships and motivate patients to engage with their (self-) care. 257,262 l A key facilitator highlighted by several authors is the commitment of the health-care system 229,232,235,253,261,262,275 and/or local practice or clinic 236,277 with ongoing evaluation. 232 l There are practical barriers if ongoing funding or resources (including time) are insufficient to enable complex interventions to be sustained.…”

Section: Implementation Systematic Reviewmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Intervention Description and Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%